Box 2.

Schematic development: pathway step categories and definitions

Schematic step	PCP assessment of cancer risk and direct access investigations	Referral for further investigationa	Resulting action from referral
Pathway step overview	This step represents the initial PCP assessment of a patient in a primary care setting including simple tests PCPs can request or directly refer to (for example, bloods, urine sampling, physical assessment, and imaging) and referrals for secondary care investigations that PCPs can directly access, without requiring approval or referral from secondary care	This step details what options PCPs have for referral after patient presentation of suspected cancer. This includes designated referral pathways (where available), the existence of managed routes defined by referral guidelines, and referrals to specific healthcare settings (for example, emergency assessment or diagnostic centres). Referrals may be assigned by PCPs as urgent or standard depending on symptom presentation	This step encompasses the result of the PCP referral, likely occurring in secondary care. Predominantly, this relates to specialist assessment of the patient, including referral for investigations. This step also captures any additional steps or decision-making points after PCP referral
Pathway step definitions	PCP assessment of cancer risk: Initial PCP assessment of patient including: PCP-led investigations: Simple tests PCPs perform or refer to directly (for example, clinical examination, urine sampling, and blood tests) PCP direct access to investigations: PCP direct access referrals to secondary care investigations (for example, X-ray and ultrasound)	Standard referral to specialist: Referral from PCP to specialist under standard procedures; not along any cancer-specific or urgent referral pathways Urgent referral to specialist: Referral from PCP to specialist for the patient to be seen urgently; either existing as an urgent referral or via an urgent referral pathway Referral to cancer-specific pathways: Referral from PCP to specialist along a pathway developed specifically for patients with symptoms indicative of cancer Access to emergency assessment: Either PCP recommendation for the patient to attend an emergency department, or PCP requesting a specialist to see the patient on an emergency basis	Specialist-led investigations: Secondary care-led investigations — referral, interpretation, and follow-up — are secondary care clinicians’ responsibility Specialist assessment of cancer risk: Specialist examination and evaluation of patient with potential cancer, including interpretation of investigation results Urgent access to investigations: Expedited referral to diagnostic investigations/tests either from PCP or specialist; may be in standard hospital settings or in a specified diagnostic unit

^a Definitions for the steps in this pathway were less consistent across countries to reflect accurate practice and nuances in language used in guidance; further steps were developed during schematic development to reflect this. PCP = primary care practitioner.